Politics and policy

Medicare’s new bundled payments program is expected to be popular, despite unanswered questions about the target prices for the episodes, risk adjustment, and use of quality data. Here’s what we know—and don’t know.

Ezekiel J. Emanuel’s Prescription for the Future is true to its title and proposes a five- to 10-year agenda for transforming expensive, wasteful American health care into a system that delivers high-value care. This is a qualitative book based on case studies that identify and systematize how to improve quality, patient experience, and cost.

The medical home model for delivering health care is getting tested for people with mental health problems. Missouri has been a pacesetter. By using a cost-based prospective payment system for health home patients, Missouri Medicaid shifted providers’ emphasis from periodic acute care-to-care management with a focus on preventing high-cost exacerbations.

CMS chief Seema Verma wants to reshape the entitlement program that covers about 62 million people. Verma endorses “community engagement”—work or community service— as a condition for “able-bodied” people to get Medicaid coverage and accused the Obama administration of the “soft bigotry of low expectations” for opposing such a requirement.

Opioids remain the go-to products because they target the mu opioid receptor, which has been shown to be the most effective pathway to reduce pain. The holy grail for drug developers is an agent that stifles pain without producing the euphoria and addiction of opioids.

Blame for the epidemic has focused on drugmakers, drug wholesalers, and physicians who prescribed opioids too liberally. This fall, fingers pointed at health insurers. Investigative reporting showed that coverage policies that restricted access to less addictive medications might have helped fueled the epidemic.

Whether in a red or blue state, the state commissioner jobs do require decent working relationships with insurance companies, particularly in precarious times as insurers threaten to leave some areas with no ACA coverage because of poor market conditions or dithering in Washington, D.C.